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Management of glioblastoma in older adults

Tracy Batchelor, MD, MPH
Helen A Shih, MD
Section Editors
Jay S Loeffler, MD
Patrick Y Wen, MD
Deputy Editor
April F Eichler, MD, MPH


Approximately one-half of patients with glioblastoma are 65 years of age or older at the time of diagnosis. Among clinical factors affecting prognosis, older age and poor performance status have consistently been shown to be associated with shorter survival. The poorer prognosis of older adults and the relative lack of clinical trial data in this age group have led to uncertainty about optimal management. Treatment decisions in older adults can be additionally complicated by factors such as comorbid disease, polypharmacy, increased susceptibility to side effects, and social and economic vulnerability.

The available evidence and approach to older adults with glioblastoma will be reviewed here. The general approach to surgery, radiation therapy, and adjuvant chemotherapy for patients with malignant gliomas is discussed separately. (See "Clinical manifestations and initial surgical approach to patients with high-grade gliomas" and "Initial postoperative therapy for glioblastoma and anaplastic astrocytoma", section on 'Temozolomide' and "Adjuvant radiation therapy for high-grade gliomas".)


Older adults with glioblastoma have a worse prognosis compared with younger patients [1]. In population-based studies, the median survival of patients 65 years of age and older with newly diagnosed glioblastoma is approximately six months [2-4]. Older adults also tend to receive less aggressive therapy, which may influence outcomes [5-7].

The most important prognostic factors affecting survival in patients with malignant glioma are age and performance status (table 1). In a large retrospective study that included over 700 patients with glioblastoma diagnosed at 70 years of age or older, the median age at diagnosis was 75 years and the median Karnofsky performance status (KPS) was 70 [8]. Recursive partitioning analysis revealed four prognostic groups, with median overall survival stratified according to age and performance status as well as extent of resection:

Subgroup I (gross total resection or partial resection, age <75.5 years) – 8.5 months


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Literature review current through: Sep 2016. | This topic last updated: Aug 11, 2016.
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